Fiz—ee-at’-trist” with emphasis on the third syllable. When naming the doctors who carry out the work to which he dedicated his life (Physical Medicine and Rehabilitation or PM&R) Frank Hammond Krusen stressed the third syllable rather than the second in order to distinguish physiatrists from psychiatrists. Although healthcare professionals and internet searches today are still confusing the two words, the field of PM&R has grown exponentially from the small branch of medicine that first drew Krusen’s admiration. According to the American Academy of Physical Medicine and Rehabilitation, PM&R is unique in its emphasis on patient function rather than disease on prevention, diagnosis, treatment, and rehabilitation.1 It is difficult to identify one person as the founder of an entire medical specialty, but Frank H. Krusen is the undisputed founder of PM&R,1,2 and his dedication has transformed restorative care in America.

Early life

Krusen was born in 1898 in a Quaker household in Philadelphia, Pennsylvania.2,3 From youth he was personable and outgoing.2 His father was an obstetrician and gynecologist at Jefferson Medical College, where Krusen later attended medical school.2,3 Also, Krusen’s father was Philadelphia’s director of public health, and instilled in his son a strong dedication to community service.2,3 After graduating third in his medical school class and marrying Margaret Borland, Krusen began a surgical residency,2 then contracted pulmonary tuberculosis.1,3 Following five months in a tuberculosis sanitarium, Krusen returned to medicine, but this time with a new interest—the fledgling specialty of physical medicine3 and a realization of the importance of physical and occupational therapy in achieving reintegration into society.2 Henceforth he would devote his life to promoting the incorporation of physical medicine in the care of debilitated patients.

Eyes on his goal, Krusen was appointed associated dean of Temple University’s medical program at the young age of 28.3 Under his guidance the program flourished, establishing Krusen as a capable leader in medicine.3 It was at Temple that Krusen first served as the football team’s physician.2,3 He won the admiration of fans when injured players under his care were able to return to play in record times.2 He also pioneered physical medicine research, realizing the necessity of evidence-based medicine in advancing knowledge of physical medicine and establishing it as a science.2,3

Foundation of physical medicine

Krusen’s restorative success with physical modalities did as much to promote his cause as his research. The reputation of hard work and medical excellence that Krusen developed at Temple, combined with the satisfaction of patients receiving his care, made it possible for Krusen to establish the nation’s first department of physical medicine at Temple in 1928,1,3,4 as well as a training program for future physical medicine physicians.2,3,5 Although Krusen would work at other institutions, he would return to Temple at the end of his long career to further refine the program and build it into one of the most prestigious in America.3 But it was Krusen’s appointment as chair of Physical Therapy at the prestigious Mayo Clinic in 1935 that helped launch the development of modern PM&R.1,3,5 In response to recommendations and Krusen’s success at Temple, William Mayo asked Krusen to develop a similar physical medicine program at Mayo.2 During his first seven years at Mayo, Krusen’s efforts led to an 83% increase in the physiotherapy patient population.3,7

Physical medicine in wartime

Krusen recognized the important role physical medicine could play in caring for soldiers returning from battle.3 He produced papers promoting the use of physical medicine during this time, on topics ranging from physical disabilities in the military, pain management, musculoskeletal conditions, and even rehabilitation from frostbite acquired in the trenches.2 Following the onset of World War II in 1941, physical medicine physicians played an important role in restoring functional capacity to injured soldiers.1 His efforts convinced the US War Department and US Navy on the merits of physical medicine treatment for their soldiers, and these military groups later became strong advocates for establishing a unique PM&R medical specialty.1 Demand for physical medicine continued to increase in times of war or during epidemics such as the polio epidemic from 1952-1955.1

Physical medicine gains national support

How could one man conduct research, train students and residents, while also treating patients and lobbying for the development of a medical discipline? Krusen did all this in a short, highly productive period of time, and he did it very well. In 1941, he wrote the first Physical Medicine textbook, an 800-page volume entitled Physical Medicine.2,3,8 A monumental work for students and health care professional alike, even the U.S. government adopted Krusen’s work as their military physical medicine textbook.2

A good idea can spread like wildfire, but a spark is needed to ignite the flame—and the galvanizer is usually money. Collaborating with his wealthy patron M. Bernard Baruch, Krusen found the spark he was looking for. A physician scientist himself, Baruch had published on the effects of hydrotherapy, and was interested in advancing physical medicine to a national status, being willing to donate large sums of money to achieve this goal.9,10 Krusen pounced on this opportunity, accepting the role of Director-Secretary of the Baruch Committee.9 The Committee allocated $1.1 million to medical schools across the country for establishing PM&R programs.2,3,9 Promoting this specialty field was not easy—in his duties as Director-Secretory, Krusen reported traveling distances equivalent to traversing the globe 1.5 times, and recorded sleepless nights in his diary as he faced obstacles in having this new field accepted.9

PM&R as a unique medical specialty

As a culmination of Krusen’s efforts, he and his colleagues succeeded in establishing PM&R as a unique medical speciality.3 In 1947, PM&R was recognized by the AMA as a certified medical specialty, PMR residencies were established in 25 hospitals, and 80 physicians took the PM&R qualifying board examination.1 Krusen and colleagues had been known as “physical therapy doctors” but henceforth Krusen dubbed doctors who practiced PM&R “physiatrists.”1 Fittingly, Krusen was selected as first chairman of the American Board of Physical Medicine.3 It was only later that “rehabilitation” was recognized as an important adjunct to physical medicine, due to the efforts of PM&R pioneer Howard Rusk.3 Krusen supported Rusk’s efforts to merge the two disciplines while maintaining the distinct focuses of each.3,8 Throughout Krusen’s endeavors to establish PM&R, he kept a diary. Following Krusen’s death in 1973, his family donated a copy of his diary to the Mayo Clinic’s History of Medicine library.2In this diary, the rich history of the development of PM&R is preserved in detail, and this has now been published online.

PM&R today

Today, PM&R is one of the certified medical specialties, and it is gaining in popularity. The American Academy of PM&R has over 9,000 members,1 and 77 medical schools offer PM&R residencies.3,11 Physiatrists enjoy a breadth of career options—from pediatrics, to traumatic brain and spinal cord injury, to sports medicine, and pain management. They work in academic and private settings. Research abounds and the field has its own peer-reviewed research journal—PM&R. There are still abundant opportunities for research and discovery, making PM&R an exciting career for both healthcare providers and medical scientists. Despite the ever-growing demand for physiatrists, many medical students are unaware of the existence of a PM&R residency by the time they apply. Thus, efforts must still be made to promote awareness of the discipline to attract top-notch practitioners and improve restorative care in America. Krusen built a strong foundation for the field of PM&R, and it is now up to the students he trained and their trainees to continue his legacy.

The highest honor in PM&R is the Frank H. Krusen Lifetime Achievement Award, granted to an individual who contributes greatly to the field of PM&R. Thanks to Krusen’s foresight, innovation, dedication, and passion for physical medicine, PM&R has revolutionized patient care, helping millions regain function and attain better quality of life.

References

American Academy of Physical Medicine and Rehabilitation. The Medical Student’s Guide to PM&R. Retrieved from http://www.aapmr.org/career/students/PMRspecialty/Pages/medical-students-guide-to-pmr_b.aspx. Accessed on October 8, 2014.

Opitz, J.L. (1997) The History of Physical Medicine and Rehabilitation as Recorded in the Diary of Dr. Frank Krusen: Part 1. Gathering Momentum (the years before 1942). Arch Phys Med Rehabil, 78: 442–445.

KRUTIKA PARASAR, ScB, is a 3rd year medical student at Rutgers-Robert Wood Johnson Medical School. She is a lover of science and the humanities, and the overlap of the two. She writes this piece as a tribute to the father of the medical specialty of Physical Medicine and Rehabilitation (PM&R)—Frank H. Krusen. She has great admiration for the work of physiatrists and hopes to educate more medical students about the history of PM&R and work of physiatrists, as despite the field’s progress, it is still under-recognized in medical school curriculum.